'Radical overhaul' of NHS care following Stafford Hospital scandal

New independent inspector of hospitals to become 'chief whistleblower' as Government announces NHS trusts will have a legal duty to be honest about mistakes following report into Stafford scandal

The Government has announced a ‘radical overhaul’ of the NHS in the wake of the Stafford Hospital scandal, pledging to ‘stop tinkering around the edges’ and put ‘high quality care and compassion at the heart of services’.

Health Secretary. Jeremy Hunt, this week announced how a ‘culture of compassion’ will be a key marker of success in the future, spelling an end to the ‘distorting impact of targets and box ticking’ that led to the failings at Stafford.

The health and care system must change. We cannot merely tinker around the edges – we need a radical overhaul with high-quality care and compassion at its heart

He spoke out following the publication of the results of the Francis Inquiry, which ruled more than 1,200 deaths at the hospital were ‘unnecessary’ and that patients were ‘routinely neglected’.

Hunt has promised that in the future basic values of dignity and respect will be central to care training and, if things go wrong, patients and their families will be told.

The Government is introducing radical new measures to achieve these goals, including Ofsted-style ratings, a statutory duty of candour for organisations that provide care and are registered with the Care Quality Commission, and a pilot programme that will see nurses working for up to a year as healthcare assistants as a prerequisite for receiving funding for their degree.

This week’s response is accompanied by a statement of common purpose signed by the chairmen of key organisations within the health and care sector. It renews and affirms the commitment to the values of the NHS as set out in the NHS Constitution, and includes pledges to work together for patients; to always treat patients and their families with compassion, dignity and respect; to listen to patients; and to act on feedback.

Hunt said: “The events at Stafford Hospital were a betrayal of the worst kind. A betrayal of patients, of the families, and of the vast majority of NHS staff who do everything in their power to give their patients the high-quality, compassionate care the deserve.

The response finds the right balance between external assurance measures and internal changes focused on transforming the NHS culture

“The health and care system must change. We cannot merely tinker around the edges – we need a radical overhaul with high-quality care and compassion at its heart. Today I am setting out at initial response to Robert Francis’s recommendations. But this is just the start of a fundamental change to the system.

“I can pledge that every patient will be treated in a hospital judged on the quality of its care and the experience of its patients. They will be cared for in a place with a culture of zero harm, by highly-trained staff with the right values and skills. And, if something should go wrong, then those mistakes will be admitted, the patient told about them, and steps taken to rectify them with proper accountability.

”I and the chairmen of key organisations involved in care have pledged to do this and to make our health and care system the best and safest in the world.”

The response to the Francis Report includes plans to:

Put in place a culture of zero harm and compassionate care

  • There will be a new regulatory model under a strong, independent Chief Inspector of Hospitals
  • The Chief Inspector will introduce single aggregated ratings. The Nuffield Trust rightly said that in organisations as large and complex as hospitals a single rating on its own could be misleading. The Chief Inspector will also develop ratings of hospital performance at departmental level. This will mean that cancer patients will be told of the quality of cancer services, and prospective mothers the quality of maternity services
  • The Chief Inspector of Hospitals will assess hospital complaints procedures
  • The CQC will move to a new specialist model based on rigorous and challenging peer review. Assessments will include judgements about hospitals’ overall performance including whether patients are listened to and treated with dignity and respect, the safety of services, responsiveness, clinical standards and governance
  • A new Chief Inspector of Social Care will ensure the same rigour is applied across the health and care system. The merits of having a Chief Inspector of Primary Care are also being explored
  • The NHS Confederation will review how to reduce the bureaucratic burden on frontline staff and NHS providers by a third

Detect problems quickly

  • A new statutory duty of candour will ensure honesty and transparency are the norm in every organisation overseen by the CQC
  • The new Chief Inspector of Hospitals will be the nation’s whistleblower-in-chief
  • Publishing survival results improves standards, as has been shown in heart surgery. Survival rates for a further 10 disciplines, including cardiology, vascular and orthopaedic surgery, will now be published
  • A new set of fundamental standards will be introduced to make explicit the basic rights that anyone should expect of the NHS. They will be produced by the Chief Inspector of Hospitals, working with NICE, patients and the public
  • Where these standards are breached, a new failure regime will ensure that firm action is taken swiftly. If it is not, the failure regime could lead to special administration with the automatic suspension of the board

Accountability for wrongdoers

  • The Goverenment will consider the introduction of legal sanctions at a corporate level for providers who knowingly generate misleading information or withhold information from patients or relatives
  • The General Medical Council, the Nursing and Midwifery Council and the other professional regulators have been asked to tighten and speed up their procedures for breaches of professional standards
  • The Chief Inspector of Hospitals will also ensure that hospitals are meeting their existing legal obligations to ensure that unsuitable healthcare assistants are barred

Leadership and motivation of NHS and social care staff

  • NHS-funded student nurses will spend up to a year working on the frontline as healthcare assistants as a prerequisite for receiving funding for their degree. This will ensure the people who become nurses have the right values and understand their role
  • Nurses’ skills will be revalidated, as doctors’ are now, to ensure their skills remain up to date and fit for purpose
  • Healthcare support workers and adult social care workers will now have a code of conduct and minimum training standards
  • The Chief Inspector will ensure that hospitals are properly recruiting, training and supporting healthcare assistants, drawing on the recommendations being produced by Camilla Cavendish
  • The Department of Health will become the first department where every civil servant will gain real and extensive experience of the frontline

The Government is also today publishing a revised NHS Constitution following a recent public consultation. It incorporates many of the changes that were consulted on and, where possible, further changes resulting from additional suggestions heard through consultation.

In cases where patients have been harmed or worse, both senior managers and their legal advisers have generally decided their first duty is to the interests of the trust. This new legal duty will rebalance that

It is likely there will be a further consultation later in the year on further changes to the code of practice, with the aim of incorporating further recommendations made in the Francis Report .

The Government’s response has been widely welcomed. Mike Farrar, chief executive of the NHS Confederation, said: “The response finds the right balance between external assurance measures and internal changes focused on transforming the NHS culture.”

Peter Carter, general secretary of the Royal College of Nursing, added: "In cases where patients have been harmed or worse, both senior managers and their legal advisers have generally decided their first duty is to the interests of the trust. This new legal duty will rebalance that."

However, he said he was disappointed there would not be a registration system for healthcare assistants.

And Roger Taylor, director of Research at Dr Foster Intelligence, said the Government should have pushed forward recommendations that meant health operators would have to closely monitor and publicly report outcomes from trust to consultant level. This, he claims, would address calls made in the Francis Report for new measures to ensure that the public, patients and trust board fully understand the comparable quality of care provided across the NHS.

“Such a system of paying close attention to performance data in real time would prevent failures from happening in the first place, so we're not left relying on a ‘duty of candour’ to admit to mistakes once they've already occurred,” he added.

Further criticism came from health think tank, 2020health, which while welcoming the new plan for nurses to train as healthcare assistants, claimed this ignored problems with how older people are treated in wider society.

Julia Manning, chief executive, told BBH: “There has been a sea change in society. The respect and deference once a given for the elderly is no longer a given. There is a more fundamental problem to be considered.”

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